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Case Reports
. 2021 Apr 15;12(4):4477-4481.
doi: 10.19102/icrm.2021.120407. eCollection 2021 Apr.

An Incessant Tachycardia: What Is the Mechanism?

Matthew J Singleton  1 , Jayanthi N Koneru  2 , Prashant D Bhave  1 , S Patrick Whalen  1
Affiliations
Case Reports

An Incessant Tachycardia: What Is the Mechanism?

Matthew J Singleton et al. J Innov Card Rhythm Manag. .

Abstract

A 39-year-old man presented with lifelong palpitations, a mildly reduced left ventricular ejection fraction, and incessant tachycardia. Electrocardiography revealed a regular, one-to-one supraventricular tachycardia with superiorly directed P-waves and a long R-P interval. The differential diagnosis of the tachycardia, response to invasive electrophysiologic maneuvers, and treatment with catheter ablation are discussed.

Keywords: Activation mapping; orthodromic reciprocating tachycardia; permanent junctional reciprocating tachycardia; radiofrequency ablation.

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Conflict of interest statement

The authors report no conflicts of interest for the published content.

Figures

Figure 1:
Figure 1:
Presenting 12-lead ECGs. A: A regular, one-to-one supraventricular tachycardia with superiorly-directed P-waves and a long-R–P interval. B: Premature atrial beats at a fixed coupling interval with P-wave morphology similar to that seen during tachycardia; induction of tachycardia in sinus rhythm; variability in ventriculoatrial time, which prolongs over the course of the run of nonsustained tachycardia; and termination with an atrial depolarization.
Figure 2:
Figure 2:
A: Response to His-refractory premature ventricular depolarization. B: Response to ventricular overdrive pacing.
Figure 3:
Figure 3:
A: Electroanatomic map of the atrial activation sequence, demonstrating atrial insertion of the pathway just anterior to the coronary sinus ostium. B: Fractionated electrogram at the effective site preceded the initiation of the P-wave by 48 ms. C: Termination of the tachycardia with block in the retrograde limb after 3.5 seconds of radiofrequency energy delivery.
See this image and copyright information in PMC

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